Clearly, John McCain isn’t reading the blog. Consider this McCain utterance by way of Josh Marshall:

“Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”

We’ve been through this before, but the key point is this: people don’t want exciting ‘health insurance products’, they want adequate care when they are sick. Also, how are we supposed to choose the ‘right’ healthcare? From the Mad Biologist’s archive:

I had a total of seven different health insurance plans to choose from, three of which were HMOs. The HMOs were the most interesting: the most expensive was $173/month (for an individual), and the least was $118/month. As far as I could tell based on the benefits package, the $118/month was the “you are legally required in Massachusetts to have health insurance, but if anything happens other than an annual checkup, you’re hosed” plan. But I could be wrong: maybe someone paying $173 per month is just wasting his or her money. Or maybe we’re both screwed if something bad happens.

The problem is that I have no way to evaluate how good any of these plans are at keeping me healthy, which is what I care about….

…none of us have any way to evaluate if the insurance we have picked will provide the healthcare we need if something disastrous (or even mildly annoying) strikes. I have no idea if something bad happens (and there are many kinds of ‘somethings bad’) whether my plan will provide the healthcare I need. Would I have access to the specialists I might require? Which treatments would be covered, and for how long?

Comments

McCain doesn’t understand that health insurance is not like a normal competitive marketplace. It is one where success can actually increase costs (cutting cigarette smoking, air bags). It is also one where multiple competitors actually makes the situation worse because there is little incentive for preventative care when the savings will likely accrue to a competitor.

Of course, listening to these folks one would think the idea of national health care under one umbrella (where there would be incentives for preventative care) is some wild hypothetical, instead of a well-established and successful system all over the world. McCain might as well argue that it is inevitable that we drive on the right, because obviously we can’t tell what sort of chaos would occur if the nation drove on the left.

“Exciting” products (in the advertising sense) are those things we can live very well without. It is the unexciting essentials like food and water and health care, that one might get pretty excited about if they are not available.

Suppose I break a leg playing touch football; great time to start spending 2 weeks shopping for the cheapest leg doctor around. Competition will be fierce, so the tag price for fixing a leg will go down. Maybe.

I have a solution. Deregulate the police. Open up law enforcement to the free market.

Then, if your insurance company won’t pony up the money, you go in with a gun, lock them in cages, and hold them for ransom — which should pay your medical bills and leave you with extra money for better weaponry.

If you don’t have the belly for that, put in a call to a couple of guys named Vinnie and Momo. They will collect, no question about it. All they ask is their ten points.

You may object that this is not how civilized people go about things. Well, who is going to civilize the insurance companies? We need the military out of the Middle East and back here on the home front invading the insurance racket.

It’s just crazy to put health care into the hands of people whose motivation is to make as much money as they can by spending as little money as they can.

I’m not blaming insurance companies – they have their mandate, their legal obligations, and their stockholders to answer to. But that doesn’t mean they should be in the health care business – it means they shouldn’t be.

As a contributor to the NHS, I’m not about to claim that it’s the best health system in the world, but by any rational measure it’s vastly superior to what you have to put up with in the USA, (except for those who are rich).

I don’t quite understand why you put up with it: there must surely be more voters for whom health care is a real and present issue than those who are wealthy enough to be able to afford the best care.

Is it simply that people are conned into thinking that anything and everything that smacks of socailism must by definition be dreadful? Even if that were so, there are better models to choose. The Swiss insurance system might be tolerable to Americans, (although it’s not without its own flaws). It does rely somewhat on having to support a more than usually healthy population, which helps.

I am covered by the Medicare Prescription Scam. There are people around. Occasionally I get a notice saying that a drug that I need had been covered is no longer covered. My body is very sensitive to drugs which means sometimes it takes years of trying several different drugs until we find one that works. When I have a prescriptions filled the pharmacists gets a message from the provider approving or not approving the drug, just a straight-up yes or no. It takes a phone call to the provider to find the reason for a rejection. Sometimes it’s because the drug is not covered, sometimes it’s because of the quantity or dosage or drug strength. It can take up to two weeks to get a prescription filled correctly. My monthly fees and deductibles just went up for no reason. My income didn’t go up at all. If I decide to change providers I am still at the mercy of the new providers. Uncontrolled innovative products do not work.

Simon: The simple answer is the power of the insurance companies. They can contribute oodles of $ to politicians who are willing to toe their line. They can spend oolles of $ on lobbyists [more health care lobbyists than congresscritters]. They can also spend more oodles of $ to lie to the public about any substantial health care reform proposals [Harry & Sally commercials killed substantial reform in 1993, along with mismanagement of its promotion by the Clintons].

Mike, you are hitting bullseyes all over the place with your assessment of everything that’s wrong with McCain’s “plan” for–and basic understanding of–our healthcare system.

As a health care professional-in-training, I just wanted to extend a hand your way and raise my glass of scotch in your honor this fine evening. I sincerely think that of us in the profession, despite what people seem to believe from time to time, would want nothing more than to see every American secure health insurance/coverage. The current system screws everybody–doctors, pharmacists, and most of all patients–except for Big Business.

Unless you’ve been expensively sick, your opinion about your insurance is as worthless as your opinion about how good your local fire department is. If you’re really lucky, you’ll never find out. At least fire departments aren’t in the business of denying service as often as possible.

If it really meant choice in doctors I’d be all for it. But the only choice that you actually get is choice of insurance companies. Virtually all insurance companies require you to go to their stable of pet doctors, and usually you have to get approval from your primary care physician even to see one of their specialists. If your employer offers a choice of health plans, you might be able to buy an extra-cost one that lets you bypass the primary care gatekeeper, but even then you have to go to one of their specialists or you pay extra. And it’s more extra than you think. A plan may say that it pays 70% or so of out-of-network prices, but if you actually go out of network for anything serious, you discover that the hospitals offer discounts to the insurance plans they are affiliated with. Come at them from out of network, and you get charged full retail, so it turns out that although you are supposedly only paying 30%, it is 30% of twice as much. And that doesn’t count the cost of the time you spend on the phone getting your health plan to actually pay up–because the hospital never seems to fill out the claim forms to the insurance company’s satisfaction (it’s not exactly in the company’s interest to make it easy to file a claim), so they don’t pay and the hospital starts dunning you for the bill, and you end up having to spend hours on the phone mediating between with insurance company and the hospital.

So just how is that different from having a government health plan and digging into my own pocket (or maintaining secondary health insurance) if I want health care that they won’t offer? But at least in that case I know that if I change jobs my health insurance won’t become impossibly expensive because I have “pre-existing conditions.”

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